CHECK SHEET FOR REPAIR
Please inform the following items completely for safety precautions against our
maintenance staff.
Date of issue
Customers name
Person in charge
TEL No. － － Ext.
FAX No. － －
Representative Distributor
Person in charge
TEL No. － － Ext.
FAX No. － －
Product Name Serial No.
1.Request item
(1) Trouble
situation: □ Unusual sound □ Pressure degradation
□ Irregular action □ Others
(2) Scheduled inspection ・repairing
(3) Others
2.Evacuated gas
(1) Hazardous situations for injury
YES
NONE
(2) Sort of gas
3.Operational elapsed time Approx. Hr
4.Miscerenous Information
<NOTICE>
Please use this paper by recopying for every information. When sending your
information without this check sheet, repairing may not be acceptable.
